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THR Woooooohoooooo I did it!!!!

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My surgeon told me he does 1-2 revisions per month, for the same reasons as mine (non-integration with bone) and since he's a revision specialist who performs 40-50 replacements a month, I don't think that's very many. He's not a big fan of the Anterior approach, but more because of the higher risk of nerve damage and misalignment. He likes good visualization of the femur. But an experienced surgeon makes a huge difference no matter what you do.

And my Dr. prescribed 4 weeks of PT, but Jo's right that you naturally go from walker to cane or crutches, and then that day comes where you can walk a few steps without anything. And healing goes pretty fast from there for most of us. I've called my Dr's nurse because my incision looked funny and hurt more in several areas. Another day I felt yucky and had a low-grade temp. She sweetly reminds me that what I'm going through is normal. So I think we all question our recovery now and then. I'm glad there are other Posterior replacements in my time frame, because this recovery curve has been slower.

And I can't say PT is doing anything I can't do myself. I receive exercises I otherwise may not know, or do. PT also gives me the accountability, so I work out harder because he's going to check me again in a few days. And my PT and I go back a ways, as he helped me stay as fit as I could when my stem was a problem. I enjoy working with him when we can see true progress. But it also costs money (for me).It's a luxury, not a necessity after a point - my opinion.

When you have concerns, keep asking. Someone will always have answers for you, stargirl.
 
HappyHippy I know Stargirl won't mind if we digress a little on her thread, because she's neurotic like me and always grasping for something to pin that free-floating anxiety on:heehee: so she can worry about this along with me.

I just scanned back over your thread (it took a while!) and I have a question---there may not be a definitive answer, but I'd like to know what you think. You seemed to do extremely well after your anterior THR, for about 4 months, right? and you were gung-ho PT at that time. And your revision OS says your original stem was too small. I'm wondering if the first surgery was doomed from the beginning, or if your first surgeon had ordered "no weight bearing" for a period of time, the bone would have had a chance to integrate? There are surgeons who do uncemented THRs and okay full weight bearing from the start, and others who don't.

I hope you don't mind my asking this. I've been wondering about this for a while, but didn't want to bring it up until you were post-op from your revision and doing well.
 
Sissy46,

I don't mind you asking the question at all. For bone to grow into an implant, there needs to be less than 2 mm of space between the stem and the bone after it's reamed to accept the stem. The surgeon needs to select a stem that fits tightly with little or no space, yet doesn't fracture the femur when it's press fit (pounded) into the femur. Sometimes the femur is fractured to various degrees and now and then is loose. The way you can tell if the stem has a good fit, is by looking at the x-rays. Surgeons let some, maybe most fractures heal, and they form a strong bond with the stem.

If you go to page one of my thread, I believe I have the initial and later X-rays of my stem. You'll see dark lines around both, which is called lucency. Many x-rays show some lucency to begin with, but it's less than 2 mm, as 2 mm is the magic number where it's too much space for the bone to connect with the substance placed on the stem to encourage bone in-growth with the stem.

On top of that, my stem was also misaligned. Instead of being straight into the femur, it was angled towards my back (I think it's called Varus alignment) which created additional pressure because it didn't fit my anatomy. Weight bearing or not wouldn't have made a difference.

Why did I get 3-4 months of good activity? Because I was on pain meds, and the hip can take a bit of misalignment. We have about 130 degrees of movement, so losing 20 or more of those early won't be noticed. Remember, we're walking and doing a lot of movement within limited ranges, but we're not trying to sit on the floor with our legs crossed. It took a little time for the stem movement inside my femur to be as painful as my pre-surgery hip. The loose stem problem starts being noticed at 4-6 months. But the pain is in the groin, not the stem pain you may still feel in the femur. It's normal to have pain in an uncemented stem for up to a year or more.

There's probably more people ending up with fractures of various degrees than loose stems by what I've seen here. Good surgeons check the fit of a stem before closing up. Remember, I was the second surgery in a Hospital with a new Anterior table, and this surgeon was just out of his residency. Correcting a stem broached at the wrong angle isn't a piece of cake either. My revision surgeon had to trim the trochanter down, then drill a round hole deeper into good bone. The first surgeon already knew he screwed up, and was probably out of time and skill to fix his mistakes. I had transfusions after the first surgery and woke up in horrible pain.

I just don't think either of you had this "perfect storm" of errors that will cause your stems to not grow in. We do have people showing up on the forum from time to time that had hips that were initially good, but started to have groin and/or deep hip pain. And they often end up with revisions. But surgery pain is different than loose stem pain, as I can attest to, because I just traded one for the other, and this is much easier. :)

*whew* that was a windy explanation even for me :wink: I think you both can relax, Ok?
 
HappyHippy Thanks so much for your understandable, well written answer to my question. You've become an inadvertent expert on these issues, and I appreciate it. Now I should forget about my hip and concentrate on worrying about my knee. I don't know what Stargirl will worry about, but she'll find something, I'm sure:rolleyes: It's what we do.


"Perfect storm" is a good way to describe your very unlucky situation, and I'm so glad your revision is over and done, and done well.

I've never had any of the stem pain in my femur, even though my prosthesis is uncemented. I think my OS did a really good job with the anterior approach. He went over the post-op xrays with me while I was still in the hospital, and gave me no restrictions except to avoid high impact.

I've focused my worry on something that happened two and a half weeks post-op, when I was driving home from my appointment with my OS. Someone cut into my lane and I had to hit the brake hard with my right foot, and at the same time slammed my left foot against the floorboard, too, with great pain in my hip. I went home, cried and cussed, took ibuprofen and spent the afternoon icing. Next day was fine, but I've worried that might have damaged or dislodged something. When I saw my OS 6 weeks later, though, he took xrays and said everything looked great, which should have allayed my worries, but I still worried, especially thinking about your situation.

The only other time I've had a sudden and significant pain was in December. We'd been kayaking, and I was backing my car down to the grassy area where my boat was waiting to be loaded. My left foot was on the footrest, and I twisted sharply to look over my right shoulder to make sure I wasn't about to run over my brother, and something popped painfully, outer upper thigh. It really hurt---again, went home and cussed and cried and iced, but no residual effect and it seemed the next day that the "start up" stiffness was actually better.

I'm 5 months out now, have good range of motion, no pain. My hip isn't keeping me from doing anything I want to do. You've put my mind at rest.

Off to one of my favorite creeks this morning---will send good kayaking vibes to you and bellaroma.

Again, thanks. You've probably helped many others besides me.
 
Glad I could be of help. And the main reason I've learned so much, is the amount of time I had to research what may have gone wrong with my hip. And I still wondered about things like infections and other unlikely problems until I had the surgery. That's pretty normal. My main recommendation would be that if your Hip is never pain free after surgery, or gets worse, to get a second opinion OUTSIDE of your initial surgeon's Orthopedic practice. This may mean going to a larger metro area, or looking here for a revision specialist. My second opinion was from the OS who trained my surgeon. Dumb move. Third opinion was from another surgeon in the same practice my first surgeon was in. And had another "watch and wait" result. I may have had a revision sooner if I went to the last surgeon earlier. Dr's don't tell you when they screw up, and when they do, will treat it like it's a "normal" event. They don't want to get sued, so it's understandable, but doesn't resolve your frustration.

So go where you'll get your Hip honestly assessed and hopefully fixed. And don't give up and resign yourself to a life on a walker, or other assistive devices on large amounts of narcotics. That's NOT a life!

HH
 
Hi HappyHippy I'm sure we all appreciate you taking the time to explain why people should not automatically catastrophise when we have a flare up of pain etc . Indeed every journey is individual .

Having said this the attitude of trivializing the surgery which seems to ring loud amongst some PTs and certain medical individuals and patients is not necessarily beneficial either . For the millionth time lets acknowledge it is major surgery and there are many things that can unfortunately go sour however gauging by predecessing history of the surgery and specifically taking into consideration your own surgeons track record I think we all need to make an individual judgement call and say that in l likelihood judging by the facts and history it will likely go well .

Time sweet time is all we need .
 
stargirl are you feeling like something isn't Ok? I don't mean to minimize anyone's symptoms, nor say that this is an easy surgery, even when it goes well. Probably all of us over stress the new Hip, and then have pain we didn't have before, or for awhile. And that can happen months after the surgery. Replacing any joint is a big deal. Everyone has different thresholds of pain too. There are people that actually have this surgery, and by the end of the week are controlling their pain with over the counter meds. Most of the rest of us need stronger pain killers for awhile. It's an individual journey. I'm not pain free yet, and still take pain meds. And I can't walk farther than 1/2 mile. And my cup wasn't changed. I'm not going to push it this time though, but take it slow and steady.

Reminds me of another piece of advice - try not to take all your stronger pain meds, so if you have bad pain down the road, you have something.

I think PTs and Dr's see so many joint replacements that some get a bit jaded. They've developed their program, and expect patients to hit milestones at the same time. Dr's want you to back off of pain meds after the first few weeks to avoid dependency, and PT's have their exercises they use for all joint replacements and don't individualize for the person. My PT in the hospital documented I was a difficult patient because I told her I knew how to use all the equipment, and didn't need her to demo. I don't think she read the word "Revision" in my chart. If you feel the PT is hurting you, stop or change the person. I think Jo's right when she says we'll naturally progress just by doing our everyday activities, and adding walking, biking, swimming and other exercise that won't hurt out hip.

Time is the answer, you're right, and this forum will be here to celebrate your victories, and advise if things don't seem to be going well. People who haven't had joint replacements don't understand how difficult they are. And people have short attention spans. Friends and family may stop support before we feel ready for it, because most surgeries are healed by 6 weeks. They can get tired of hearing about it or helping us.

Lots of people are supporting you and your recovery here though, Stargirl. People who do understand what you go through with a Hip Replacement. Isn't that great?!
 
Hi HappyHippy by no means was my generalization directed at you . You have been a wealth of knowledge and tremendous support , it was more just comment on my own personal interactions with people physically around me . I am over people branding us over anxious etc. I'd you don't see your OS after traumatic surgery until six weeks ummmm.... Your going to be little anxious !!!!!
Lol :loll:

I love how they go AWOL and expect your physio to get you through post surgery concerns, and yes I have access to a nurse but your surgeon is your surgeon they know what went on .

Anyways yes for sure very greatful to have access to a wonderful forum and delighted you are doing well after such an exhausting ordeal xxxx thankyou for everything and may the stars shine bright on you always .
 
Hello my Aussie stargirl.. Oh grasshopper, I sense cabin fever, frustration and a bunch of other emotions which is perfectly normal hon.

Hang in there, happier times ahead :)
 
Hello lovely girl.

Are you ok stargirl?

I'm seeing my OS for the first time next week and that will be 8wks post op. I also haven't seen or heard anything from a physio since I left hospital. I do feel rather abandoned which has often left me feeling frustrated and anxious. So I can empathise with you. I wonder how many surgeons/physios have had a THR? You kind of think ' You wouldn't treat me like this if you knew how I was feeling'. But you could say that about anyone.....Friends and family included. Most folks in the medical profession have to form a very hard exterior shell to cope with all the horrors they see. I guess this makes them come across as uncaring, which I'm sure is not actually true in most cases. My sister-in-law is at the top of the nursing tree and always comes across as very hard nosed but dig deep and there is a very caring lady in there somewhere........honest!! I've been feeling very low because my recovery, typically, has not been textbook. I feel people are thinking 'Blimey, its over 6wks, she should be back to normal by now, bet she's milking it a bit'. When in reality they probably feel very sorry for me. So on on top of everything else I'm now feeling a bit paranoid too!
When people usually see you as a positive, happy, glass half full person it puts you in a very awkward place. You feel like you should be smiling and saying 'Yeah, everything's great thanks, yeah I'm fine........No probs here'. When in fact when things don't quite go according to plan all you want to do is go and hibernate in a hole, lick your wounds and come out all mended and smiling when Spring comes.
I am of course talking about myself here, but if there's any chance you feel like this too then please believe me when I say you are most definitely not on your own. A tougher road I have never walked. It's been an experience that's for sure.

Well, I won't say too much more as I know I have a tendency to get a bit 'Airy Fairy', but you know my words come from the heart and I just wanted you to know that I'm thinking about you......Lots!

Sending you a mahoosive cyber hug.

Queenie xxxx
 
stargirl, I didn't take it personally. I know Poppet has it right. I feel the same way about some things. Healthcare in the US is different, and I saw my OS in my first visit, although it wasn't planned. He just came in because his nurse told him how well I was doing, so it was a 2 min. Ego booster. But he did see me, and will again in 2 weeks. He has 2 surgery and 2 office days. Perhaps in Australia and England, they operate more and let nurses and physician's assistants handle all the post-op drudgery. Many surgeons like to cut, but really don't like to deal with patients so much. And if they do 6 patients a day, you're quickly forgotten by the sheer volume of patients they worked on.

But that doesn't take away the feeling that you'd like to see your surgeon.

Queenie, I like what you said about others not understanding. It's so true, unless they've been there. My Mom would tell me her sister had a hip replacement and was doing fine, so she didn't understand why I was having problems before my revision. I always felt she was implying I was faking the pain. Now why would anyone choose not to have a life? It really angered me. But it wasn't until I had solid results that she believed me.

I was a bad girl yesterday, as I thought I was doing well, so I asked a friend to take me out to lunch. We ended up shopping a few hours too, but only at 2 furniture stores. They had chairs, so I thought I'd be fine. Today I have a lot of groin and back of the bum pain, so I cancelled my PT. I'm lying with a hearing pad on my back and an ice pack on the front hip. So, it's very hard to figure out what is enough and too much at 5 weeks. I'd guess this starts at about 3 weeks, when cabin fever sets in, to 8 weeks when we're pretty stable. So we have a month where our activity levels keep changing, but it's danged easy to overdo. And as Poppet said, cabin fever, expectations of other people, and many things drive us crazy.

But it will get better. And I can have lunch or go shopping. Not both. :bicycle2:
 
Wondering how you are doing Stargirl, the blue and energy drain can make us crazy. Hadn't stopped in for a while and wanted to make sure I sent out a Howdy:)
 
Hi Stargirl-
Just wanted to drop in and offer some encouragement. Going back a few days in this thread, Your PT may be overdoing it. My surgeon just wanted walking, swimming, and biking at first. No formal PT. As Josephine says, hips have a way of working themselves out. When I was where you are, recovery wise, I was still really needing to pace myself. If I had a "big Day" of activity, I needed to take it easy the next. Just remember to listen to your body, even when you are out and about. You don't have to be housebound, but don't try to squeeze too much into an outing either. I hope you are feeling better!
 
Hello Aussie girl, did you contact the OS office ahead of your appointment and insist on x-rays and also give that PT her retirement check! :)

Hugs xx
 
stargirl I wanted to ask you how long it took for your hip to recover after having your naughty shopping trip. I'm suffering from naughty shopping trip disorder (NST) and my groin muscles are killing me, but everything is unhappy. It's day 2 of being down and icing. And am sooo tired of lying around watching Netflix and reading!

Sorry to whine, but I thought I could pull it off. Guess I couldn't :(
 
HappyHippi,

I seriously overdid at 1 and a half weeks after hip op number 2 and my muscles complained BIG time.
Couldn't walk and had to spend 3 days lying on the settee feeling sorry for myself.
After that I continued on my amazing recovery path. I had to learn my lesson the hard way.

Funnily I lost my pelvic tilt in the process which was a bonus! Since then I have
listened to my body, taken it steadily and am really happy with my recovery doing
Pilates and even Zumba now.

Lots of people overdo it at some stage.
Try and be patient and I hope every thing calms down quickly for you very soon
as it did for me.

Ali x
 
Hi Mbone thankyou for asking ! I have my 5.5 week checkup tomorrow thank goodness I am going to bombard that surgeon with my questions , that is what there paid for isn't it !? :) I am walking with cane for long walks and unaided around the house , I have two more pt sessions I have had about eight because I was in such a bad state pre op ( bone on bone with AVN)
Pt says I only need two more sessions and is happy with progress she even makes me get up and down off the floor - leaning on a chair or something :/ I can walk and walk with the cane - for around two hrs and whilst I can walk without it feel a little stiffness after a while if cane is absent so I am happy to keep it as required . I can't wait for the day I truly don't need it !

It has been an arduous exhausting journey to say the least but at least I can see micro improvements every day like being able to bend down and put my own shows on and bring able to walk more than a meter without feeling agony !!!!
I was at stage shopping trolley was my walker and then out for two days if I did go shopping or cook dinner etc !!

I can now see the light thank goodness , I guess just did not fully appreciate how intensive recuperation would be or how major surgery is thank goodness sunshine is ahead !!

How are you?
 
stargirl When you walk without your cane do you limp? I limp without it. I still don't think my leg is strong enough. In addition, I have two bad knees also! I want to be cane free so bad but I'm afraid my bone on bone knees won't allow it!
 
Hi Mbone I believe after a period yes I do start to limp without the cane, particularly if I have overdone it with walking . Check with your pt but I would not be too concerned I suspect it is residual muscle weakness that makes us still limP without the aid, who cares If we take an additional period of time with the cane I am sure we will get there in the end ! :) I'll tag our lovely Josephine to see what her thoughts are .
 
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